MEDITERRANEAN DIET IMPROVES DEPRESSION

Diet matters when it comes to mental health.  Two recent trials have found that when people with severe depression follow the Mediterranean diet, they experience significant improvement in mental health.  The effects were shown to last up to 6 months.  

In the most recent randomized controlled trial to examine the effect of the Mediterranean diet on individuals with severe depression, researchers recruited 152 adults aged 18-65.  Participants were randomly assigned to the Mediterranean diet or control group. The Mediterranean diet intervention included an initial nutritional consultation, biweekly group cooking workshops, easy, inexpensive recipes, and take-home food hampers for making the recipes.  Some of the intervention group was also given fish oil but that was found not to significantly improve outcomes.  The control group attended biweekly meetings that included social activities such as board games, book clubs, and photo sharing.  Participants’ dietary intake as well as their levels of depression, anxiety, and stress were assessed at the beginning of the study and then at 3 and 6 months.

Both the intervention and control groups experienced mental health improvements, but the Mediterranean diet brought improvement to 45% of participants while 27% of the control experienced mood improvement.  The investigators also found that the Mediterranean diet was significantly associated with lower anxiety and negative affect, and better coping and overall quality of life. Earlier in the year a smaller trial found similar results.  33% of depressive individuals in the Mediterranean diet intervention were able to put their depression in remission while only 8% of the controls achieved remission.

The Mediterranean diet is based on the dietary traditions of the island of Crete in Greece circa 1950.   It is rich in fruits, vegetables, nuts, beans, whole grains, fish, and olive oil while minimizing meat, sugar, and refined flour.  In these two studies those on the Mediterranean diet consumed per day 6 servings of vegetables (serving = ½ cup cooked, 1 cup raw), 5 servings of whole grains (serving = 1/3 cup or 1 oz), 3 servings of fruit (serving = ½ cup cooked, 1 cup raw), 2 servings of unsweetened dairy (serving = 1 cup milk/ yogurt or  1 oz cheese), 1 serving of raw nuts (serving = 1 oz or ~1/3 cup), and 3 tablespoons of olive oil.  Each week they consumed 2 or more servings of fish (serving = 2oz) while limiting themselves to no more than 3 servings of lean red meat (serving = 2oz), 2 servings of chicken (serving = 2oz), and 6 eggs (serving = 1 egg).  They also were permitted no more than 3 servings per week of sweets or refined flour products. 

What to do:  The role of diet in mental health has been underappreciated in the past but it is increasingly an area interest.  Emerging research continues to elucidate how the health of the gut and its microbiome are intricately linked to our mental well being.  Besides benefiting mood, incorporating a Mediterranean eating pattern has also been found to improve cardiovascular and immune health, and lower rates of cancer, diabetes, dementia and many other chronic diseases.   Even if you are not ready to commit to all aspects of the Mediterranean diet, try more modest changes such as limiting sugary foods to a few times a week or eating 2+ cups of veggies daily.

Sources

Jacka FN, O’Neil A, Opie R et al.  A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial).  BMC Medicine 2017 15:23. Available online at:  https://doi.org/10.1186/s12916-017-0791-y

Sarris J, Logan AC,  Akbaraly TN et al.  Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2015; 2 (3): 271. Available online at: http://dx.doi.org/ 10.1016/S2215-0366(14)00051-0

Parletta N, Zarnowiecki D, Cho J, et al.  A Mediterranean dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).  Nutritional Neuroscience 2017; 0:0. Available online at:  https://doi.org/10.1080/1028415X.2017.1411320

Adapted from articles available at:

https://www.sbs.com.au/news/mediterranean-diet-can-beat-depression-research-suggests

https://www.medscape.com/viewarticle/890506

UNTREATED OBSTRUCTIVE SLEEP APNEA HAS IMMEDIATE & LONG-TERM HEALTH CONSEQUENCES

A recent study underscores the importance of consistently treating obstructive sleep apnea (OSA).  The research trial revealed that when individuals with sleep apnea do not use their continuous positive airway pressure (CPAP) devices, even for just a couple of days, they experience marked increases in blood sugar, stress hormones, and blood pressure.  Another recent study concluded that over time untreated sleep apnea increases the build-up of amyloid beta, the plaque-building peptides associated with Alzheimer's disease. 

An estimated 25% of adults and 45% of obese adults have obstructive sleep apnea in which one's airway momentarily closes multiple times per hour during sleep. Treatment typically entails wearing a mask that provides air pressure into the throat to keep the airway open during sleep but there are also other less intrusive treatment options that can work in some cases.

"This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night," said study senior author Dr. Jonathan Jun.  In the study, researchers monitored 31 obese individuals as they slept. All the subjects had moderate to severe obstructive sleep apnea and were monitored either while using a CPAP device or after not using it for two nights.  During the night, researchers measured levels blood fatty acids, insulin, glucose and the stress hormone cortisol. They found that having not worn the CPAP for two previous nights resulted in elevated heart rate and reduced blood oxygen. CPAP withdrawal also increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA, the more these parameters increased.

Another recent report finds that OSA puts elderly at greater risk of developing Alzheimer's disease.  Researchers from this study report that biomarkers for amyloid beta, the plaque-building peptides associated with Alzheimer's disease, increase over time in elderly adults with OSA in proportion to OSA severity. Thus, individuals with more apneas per hour had greater accumulation of brain amyloid over time.

What to do:  These studies emphasize the importance of treating OSA to prevent its metabolic, cardiovascular, and neurological consequences.  Indications one is at increased risk for OSA include obesity, particularly in the upper body and neck, daytime sleepiness, snoring, and waking at night feeling like one cannot breath.  Maintain a healthy weight or work on weight loss to minimize your risk for OSA.  Screening with a sleep study can reliably diagnose OSA but  many diagnosed individuals find it difficult to tolerate wearing their CPAP device. In this case work with a sleep specialist with whom you can explore the various CPAP mask options and potential alternative OSA therapies including implanted devices, dental appliances, and positional therapy. 

Adapted from articles available at:

https://www.medlineplus.gov/news/fullstory_168254.html

https://www.sciencedaily.com/releases/2017/08/170831101454.htm

https://www.sciencedaily.com/releases/2017/11/171110084325.htm

Sources

Chopra S, Rathore A, Younas H et al. Obstructive sleep apnea dynamically increases nocturnal plasma free fatty acids, glucose, and cortisol during sleep. The Journal of Clinical Endocrinology & Metabolism, 2017; DOI: 10.1210/jc.2017-00619

Sharma RA, Varga AW, Bubu OM et al. Obstructive sleep apnea severity affects amyloid burden in cognitively normal elderly: A longitudinal study.  American Journal of Respiratory and Critical Care Medicine, 2017; DOI: 10.1164/rccm.201704-0704OC

GUM DISEASE MAY INCREASE STROKE RISK

A new study further strengthens the scientific evidence that cardiovascular health is deeply connected to oral health.  It found that the more severe an individual’s gum disease, the greater their stroke risk.  The study also found a strong association between regular dental care and reduced stroke risk.

Periodontal disease is a chronic inflammatory disease caused by bacterial colonization that affects the soft and hard structures that support the teeth. Gum disease is widespread. In the U.S. more than half of adults age 30 and older have have periodontitis, the more advanced form of periodontal disease.

Previously, observational studies have found that poor gum health is associated with an increase in stroke risk. However, long-term, population-based research on this topic is lacking.  For this study, researchers used data from dental exams performed on more than 6,730 participants in the Atherosclerosis Risk in Communities study. The study enrolled more than 10,000 middle-aged adults in 1987 and 1989, and then studied their long-term health outcomes through 2012.

Researchers found participants with any form of periodontal disease, including mild periodontal disease, were significantly more likely to experience an ischemic stroke than those with healthy gums. And, the more severe the gum disease, the greater the stroke risk.  This was true even after adjusting for potential confounding variables including race, education level, smoking status, age, education, diabetes incidence, hypertension, high cholesterol, and body mass index.  Interestingly, further detailed analysis found that inflammation of the gums rather than the level of bacterial infiltration of the gums appeared to be the real driver between periodontal disease and stroke incidence.

The study also examined links between better oral care and reduced stroke rates.  The findings showed that compared with those who only had dental care when experiencing problems, regular dental care users had a significantly lower risk for ischemic stroke.  Even after the analysis controlled for known stroke risk factors, regular dental care use continued to be associated with lower rates of ischemic stroke. 

What to do:  Observational studies suggest gum disease may increase risk for a host of chronic diseases including mouth and upper GI cancers, infertility, and diabetes.  This study shows a graded association between gum disease severity and stroke risk but it does not demonstrate that gum disease causes increased stroke risk. For the definitive answer, stay tuned.  A current trial is now investigating whether increased periodontal care can reduce stroke risk. In this trial patients with gum disease who have already had a stroke are being assigned to either standard or intensive periodontal treatment.  In the meantime, you can’t go wrong by practicing good oral hygiene including having a thorough home cleaning routine with brushing and flossing and regular dentist and hygienist visits.  Not smoking, managing your weight, reducing stress, controlling chronic conditions such as diabetes, and consuming a healthy fiber rich diet also support better gum health as well as better cardiovascular health.

Information adapted from:

https://www.medscape.com/viewarticle/891550

Source:

Sen S, Giamberardino LD, Moss K et al.  Periodontal disease, regular dental care use, and incident ischemic stroke.  Stroke. 2018, originally published January 15, 2018.  Available at: https://doi.org/10.1161/STROKEAHA.117.018990

REDUCE COLON CANCER RISK BY INCREASING INTAKE OF WHOLE GRAINS AND DECREASING MEAT

The American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) recently updated information on diet, lifestyle and colon and rectal cancer risk.  Their extensive research review of over 100 studies found there is strong evidence of links between lifestyle and colorectal cancer risk.  An estimated 47% of American’s colorectal cancers, 63,700 cases, could be prevented each year with lifestyle changes. The 2017 report is the first by the AICR/WCRF to conclude there are substantial benefits to eating more whole grains (such as brown rice and 100% whole-grain bread) for reducing colon cancer risk.  Consistent with earlier reviews they found regular physical activity, healthy weight, and not smoking also lower one’s odds of bowel cancers.  Alcohol, meat, and particularly processed meats were found to increase risk of colon and rectal cancer.   

The AICR/WCRF found that three servings (a serving equals 1 slice of bread or ½ cup of cooked grains) a day of whole grains can lower colorectal cancer by 17%.  Other sources of dietary fiber including fruits, vegetables, beans, and nuts, as well as dairy products and calcium supplementation were also deemed beneficial for lowering colon cancer risk.  Besides their fiber, plant foods contain a wide variety of substances that have been linked to lower risk for cancer, including carotenoids, selenium, lycopene and many more.   Fruits and vegetables rich in vitamin C such as strawberries, oranges, and spinach appear to be especially beneficial. Interestingly, regular intake of garlic was also linked to reduced risk.  Exactly how garlic contributes to lower risk is not known but in many laboratory studies, garlic and its components such as allyl sulphur compounds, has shown the ability to slow and stop the formation of colon tumors.   The panel also recommended at least 30 minutes of daily physical activity.   

As for foods to decrease, AICR/WCRF experts advised limiting intake of all red meat, such as beef or pork, to no more than about 17 ounces (i.e. just over 1 pound) per week. The report also stated it is best to eat little or no processed meats such as ham, hot dogs and bacon because frequent intake of these significantly increases the risk of bowel cancer.  Nitrates are added to many processed meats; they contribute to the production of N-nitroso compounds that can damage the lining of the gut.

What to do:  Colorectal cancer is one of the most common cancers, yet this report demonstrates healthy diet and lifestyle substantially lowers risk.  Maintain a healthy weight with a diet rich in whole grains, fruits, and vegetables. Control portions of meat, opting for fish, chicken, or beans more often.  Stay away from processed meats, alcohol, and smoking.  Also get screened.  The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 and continuing until age 75 years. 

Adapted from articles available at: 

https://medlineplus.gov/news/fullstory_168249.html

https://www.sciencedaily.com/releases/2017/09/170907093623.htm

http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/

Source:

American Institute for Cancer Research and the World Cancer Research Fund International.  Continuous Update Project Report:  Diet, Nutrition, Physical Activity and Colorectal Cancer.  September 7, 2017.  Available at:  https://www.wcrf.org/colorectal-cancer-2017.